儿童轮状病毒合并细菌性腹泻病实验室检查及临床分析

感染性腹泻病是一组广泛分布并流行于世界各地的肠道传染病,其发病率高,传播速度快,对儿童的健康危害尤其严重.引起儿童腹泻的病原微生物主要包括细菌、病毒、原虫和真菌等,其中以细菌性腹泻病[1]及A群轮状病毒(RV)感染性腹泻病居多[2].然而近年来我们在临床工作中发现了部分RV与细菌混合感染引起儿童严重腹泻的病例,这在国内尚很少报道,本研究对这部分病例进行了总结分析,旨在提高对RV与细菌混合感染所致儿童腹泻病的认识.     

2009年北京地区儿童感染性腹泻病原学及耐药性分析

目的 研究北京地区儿童急性感染性腹泻的病原学变化、流行病学特征及耐药性变迁情况.方法 对2009年1月～10月肠道门诊疑诊为细菌性腹泻病者便标本做细菌培养和血清分型鉴定,药敏试验采用纸片扩散法,以免疫层析双抗体夹心法定性检测A群轮状病毒抗原.结果 256份标本检出病原菌4种87株(有1份便标本同时检出2种菌),检出率为34.0%.男女检出比为1.69∶1,2岁以下患儿55例(64.0%).沙门菌40株(46.0%),志贺菌23株(26.4%),致泻性大肠杆菌2株(2.3%),金黄色葡萄球菌22株(25.3%).志贺菌中D群13株(56.5%),22株金黄色葡萄球菌有20株发生于＜1岁婴儿.沙门菌和志贺菌的耐药率分别为:氨苄西林(65.0%;95.7%)、复方新诺明(20.0%;78.3%)、环丙沙星(7.5%;8.7%)、头孢曲松(15.0%;73.9%).256份标本中A群轮状病毒检测阳性47份,其中同时便培养阳性者13份.结论 2009年北京地区儿童细菌性腹泻的病原菌以非伤寒沙门菌为主,志贺菌以D群为主要流行株,二者的易感人群以2岁以下婴幼儿为主,金黄色葡萄球菌感染以1岁以下婴儿为主,阳性检出男孩居多.多重耐药仍以志贺菌明显,细菌与轮状病毒混合感染的比例上升.

Abstract：

Objective To investigate the etiology, epidemiologic features and drug resistance tendency of acute infectious diarrhea among children in Beijing area. Methods Enteric pathogenic bacteria were isolated, cultured and identified for serotype from the stool specimens of children with the initial clinical diagnosis of acute bacterial diarrhea in the intestinal clinic from January to October in 2009 ,and the antibiotic susceptibility of bacteria was tested by disk diffusion method. The cluster A rotavirus antigen was also detected by the qualitative technique of immunochromatographic double-antibody sandwich assay. Results Of the 256 stool specimens, 87 strains of 4 species of pathogenic bacteria were detected with the detectable rate of 34. 0% ,of which 2 strains were detected in one stool sample ,including 40 strains of salmonella (46. 0%) ,23 strains of shigella (26. 4%) ,2 strains of diarrheogenic escherichia coli (2. 3%) and 22 strains of staphylococcus aureus (25.3%). The positively detected patients consisted of 54 males and 32 females with the ratio of 1.69∶1 ,of whom 55 cases (64. 0%) were under 2 years of age. Of the 13 strains of shigella, 13 were sonnei shigella (56. 5%). And of the 22 strains of staphylococcus aureus,20 were detected among the infants under 1 year of age. The rates of crug resistance to certain antibiotics were lower in salmonella than in shigella (ampicillin :65. 0% vs. 95.7% ;compound sulfamethoxazole:20. 0% vs. 78. 3% ;ciprofloxacin:7.5% vs.8. 7% ;ceftriaxone: 15.0% vs. 73.9%). Of the 256 stool specimens ,47 were found positive for cluster A rotavirus,of whom 13 were also positive in stool bacteria culture. Conclusion Salmonella is the major pathogen among children with bacterial diarrhea in Beijing in 2009, and sonnei shigella is the main epidemic strains of shigella diarrhea. lnfants under 2 years of age are the susceptible population of the above two species of bacteria, while staphylococcus aureus mainly infect the infants under 1 years of age. Multi-resistance in shigella is still serious. The incidence of mixed infections of bacteria and rotavirus increases in children with infectious diarrhea.     

北京地区儿童感染性腹泻病原学和耐药性分析

目的 研究北京地区儿童急性感染性腹泻的病原学变化、流行病学特征及耐药性变迁情况.方法 对2008年肠道门诊临床初步诊断为急性细菌性腹泻病儿童的新鲜粪便标本进行细菌分离培养和血清分型鉴定,采用纸片扩散法进行药敏试验,并以免疫层析双抗体夹心法定性检测A群轮状病毒抗原.结果 301份粪便培养共检出病原菌4种70株(有1份同时检出2种细菌),检出率为22.9%(69/301)、其中男孩检出48例,女孩21例,男女检出比为2.29:1;2岁以下患儿检出56例(81.2%).检出沙门菌32株(45.7%),志贺菌13株(18.6%),致泻性大肠杆菌6株(8.6%),金黄色葡萄球菌19株(27.1%).13株志贺菌中检出B群9株(69.2%),19株金黄色葡萄球菌中有16株发生于＜1岁组婴儿.沙门菌和志贺菌的耐药率分别为氨苄西林(61.3%、92.3%)、复方新诺明(16.1%、61.5%)、环丙沙星(9.7%、30.8%)、头孢曲松(16.1%、23.1%).301份标本中A群轮状病毒阳性30份,其中同时粪便培养阳性者10份.结论 2008年北京地区儿童细菌性腹泻的病原菌以沙门菌为主,志贺菌属中以B群为主要流行株,两者的易感人群以2岁以下婴幼儿为主,而金黄色葡萄球菌感染以1岁以下婴儿为主;多重耐药仍以志贺菌明显,沙门菌的耐药率有所上升;儿童感染性腹泻中细菌与轮状病毒混合感染的比例上升.     

北京地区2008年儿童感染性腹泻病原学分析

目的 研究儿童腹泻的病原学变化.方法 检测9843例腹泻病粪便的轮状病毒(RV)抗原,对其中疑诊细菌腹泻的301份标本做培养.结果 RV检出 2249例,全年发病,有两个高峰.便培养出沙门菌32株,志贺菌13株(B群占9株),致泻大肠杆菌6株,金黄色葡萄球菌19株.便培养证实RV并细菌感染10例.结论 2008年RV腹泻居多;细菌腹泻以沙门菌为主,志贺菌以B群为主,两者易感染2岁以下者,1岁以下易感金葡菌;RV合并细菌性腹泻增多.